The conversation around weight loss drugs like Ozempic and Wegovy has exploded recently, fueled by celebrity endorsements and their reported effectiveness. While the media spotlight often focuses on rapid weight loss and aesthetic changes, doctors and researchers are more interested in the potential of these medications to address the broader issue of obesity and its related health complications, including cancer. This article delves into the benefits and risks of medical weight loss, including prescription drugs and bariatric surgery, to provide a comprehensive overview.
The Promise of GLP-1 Agonists
A class of drugs known as GLP-1 agonists is garnering attention for its potential to revolutionize the treatment of obesity and reduce the associated cancer burden. These medications, including Ozempic and Wegovy, activate the GLP-1 receptor, stimulating insulin production, regulating blood sugar, and producing other effects that contribute to weight loss. Originally developed for diabetes, their weight loss effect was subsequently recognized.
Cancer Risk Reduction
Obesity and high body fat are linked to an increased risk of various cancers, including breast, prostate, and endometrial cancers. GLP-1 agonists may help individuals achieve a healthier body composition by reducing food cravings and lowering the consumption of highly processed foods, which are detrimental to overall health and can increase cancer risk. Some research even suggests that these medications may offer protection against certain cancers, such as colorectal cancer, through mechanisms beyond obesity reduction.
Neil Iyengar, MD, a breast cancer oncologist at Memorial Sloan Kettering Cancer Center (MSK), believes that this class of drugs will revolutionize obesity and the cancer burden that comes with it if people can get access.
Lifestyle Modifications Are Key
While GLP-1 agonists can be a valuable tool, they are not a magic bullet. Lifestyle modifications are crucial for long-term success. Dr. Iyengar recommends a high-fiber, plant-forward diet and consistent exercise, especially for individuals with cancer. The MSK Healthy Living Program helps people with breast cancer implement these lifestyle recommendations.
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Considerations for Cancer Patients
The use of weight loss medications in individuals with cancer requires careful consideration. There is limited data on the safety and efficacy of these drugs in newly diagnosed cancer patients. Concerns exist about potential interference with urgent cancer treatments like chemotherapy, radiation therapy, or immunotherapy, particularly due to the gastrointestinal side effects associated with these medications.
However, GLP-1 agonists may be considered for patients who have been tolerating cancer treatment well for a couple of months or for those on long-term hormonal therapy. Anecdotal evidence suggests that concurrent use of weight loss medications may be feasible in these cases, and it might even offer a solution for patients who discontinue hormone therapy due to weight gain.
Potential Side Effects of GLP-1 Agonists
While GLP-1 agonists offer numerous benefits, potential side effects must be considered.
Neurological and Behavioral Health
Research indicates that GLP-1RA drugs may be associated with significant benefits to neurological and behavioral health, with reduced risks of seizures and addiction to substances such as alcohol, cannabis, stimulants, and opioids.
Gastrointestinal Issues
The most commonly reported side effects are gastrointestinal problems such as nausea, vomiting, and diarrhea. In rare cases, paralysis of the stomach can occur.
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Pancreas and Kidneys
There are potential ways GLP-1RA drugs can negatively affect the pancreas and kidneys. While these adverse effects are uncommon, they can be very serious; physicians must be vigilant for signs of pancreatitis and monitor kidney function among people taking GLP-1RA medications.
Mental Health
Although rare, research in Europe suggested these drugs could lead to suicidal thoughts. The FDA concluded that there were no concerns about suicidal ideation caused by these drugs. However, if a person taking these drugs notes a depressed mood or change in anxiety level, they should discuss it immediately with their provider. Anyone experiencing a mental health crisis or contemplating suicide should call or text 988.
Thyroid Cancer
A very low risk of thyroid cancer, specifically medullary thyroid cancer, has been associated with the use of these drugs, which is of particular concern to people already diagnosed with cancer. However, the overall risk is quite rare, and the health risks associated with obesity often outweigh the risk of thyroid cancer.
Other Prescription Weight-Loss Drugs
Besides GLP-1 agonists, other prescription weight-loss drugs are available. These drugs work through various mechanisms, such as reducing hunger, increasing feelings of fullness, or preventing the absorption of fat.
Common Medications
- Bupropion-naltrexone: A combination drug that can raise blood pressure, requiring regular monitoring.
- Liraglutide: Administered as a daily shot, with nausea as a common side effect.
- Orlistat: Available with and without a prescription, this medication requires a low-fat diet and can cause gastrointestinal side effects. In rare cases, serious liver injury has been reported.
- Phentermine-topiramate: A combination drug with the potential for misuse due to its stimulant-like effects.
- Phentermine: Used for short-term weight loss, it carries risks such as increased heart rate and blood pressure, insomnia, and nervousness.
- Semaglutide: Also used for type 2 diabetes management.
- Setmelanotide: Used for specific genetic conditions causing obesity, it can lessen appetite and increase feelings of fullness.
Important Considerations
Prescription weight-loss drugs are not suitable for everyone. Healthcare providers consider a patient's medical history and health challenges before prescribing these medications. Common side effects include nausea, constipation, and diarrhea, which may lessen over time. Serious side effects are rare, but it's important to discuss all treatment options with a healthcare provider.
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Weight-loss drugs can be expensive and may not be covered by insurance. Many people regain some of the weight they lost when they stop taking these drugs. If a patient hasn't lost at least 5% of their body weight after taking the full dose of a drug for 3 to 6 months, the healthcare provider will likely change the treatment.
Bariatric Surgery: An Alternative Approach
Bariatric surgery, also known as weight loss surgery, is another option for individuals with severe obesity. It involves changing the anatomy of the stomach and small intestines to affect hormonal signals that cause weight gain or the inability to lose weight.
Types of Bariatric Surgery
Common bariatric procedures include:
- Gastric bypass
- Sleeve gastrectomy
- Duodenal switch
Benefits of Bariatric Surgery
Bariatric surgery offers numerous benefits, including:
- Significant and lasting weight loss
- Improvement or resolution of obesity-related medical conditions, such as diabetes, heart disease, high blood pressure, arthritis, and acid reflux
- Increased energy levels and enthusiasm for physical activity
- Improved quality of life and self-confidence
- Reduced risk of death related to heart disease, diabetes, and cancer
Risks of Bariatric Surgery
Like any surgical procedure, bariatric surgery carries certain risks:
- Atelectasis: Partial collapse of the lungs, which can lead to fever, pneumonia, or shortness of breath.
- Pulmonary embolism: Blood clot in the lungs, which can be life-threatening.
- Bowel leakage: Leakage of bowel contents from the new connection between the stomach and the small intestine, which can cause infection and even death.
- Difficulty eating: Narrowing of the connection between the stomach pouch and the intestine due to scar tissue.
- Other risks: Infection at the incision site, erosion of the gastric band (in gastric band surgery), gallstone formation, excessive loss of lean body mass, water and electrolyte problems, mild liver dysfunction, elevated uric acid levels, diarrhea, constipation, hair loss, and cold intolerance.
Post-Operative Care
To lessen post-operative surgical risks, programs include frequent post-op follow up at one month, three months, six months and one year. Following surgery, most patients lose weight quickly for 18-24 months. Surgery improves and sometimes resolves most obesity-related medical conditions.
Is Bariatric Surgery Right for You?
Bariatric surgery is an option for patients with severe obesity (BMI greater than 35) who have had little to no success with diet and exercise alone. It's crucial to discuss the risks and benefits of bariatric surgery with your family and doctors before making a decision.